J Korean Med Sci.  2023 Apr;38(14):e106. 10.3346/jkms.2023.38.e106.

COVID-19 Vaccine-Associated Pneumonitis in the Republic of Korea: A Nationwide Multicenter Survey

• Yoo H
• Kim SY
• Park MS
• Jeong SH
• Park SW
• Lee HL
• Lee HK
• Yang SH
• Jegal Y
• Yoo JW
• Lee J
• Kang HK
• Choi SM
• Park J
• Kim YW
• Song JW
• Park JH
• Choi WI
• Choi HS
• Park C
• Park JW
• Chung MP

• KMID: 2541548
• DOI: http://doi.org/10.3346/jkms.2023.38.e106

Abstract

Background
Recent reports have suggested that pneumonitis is a rare complication following vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, its clinical features and outcomes are not well known. The aim of this study was to identify the clinical characteristics and outcomes of patients with vaccine-associated pneumonitis following vaccination against SARS-CoV-2.
Methods
In this nationwide multicenter survey study, questionnaires were distributed to pulmonary physicians in referral hospitals. They were asked to report cases of development or exacerbation of interstitial lung disease (ILD) associated with the coronavirus disease 2019 vaccine. Vaccine-associated pneumonitis was defined as new pulmonary infiltrates documented on chest computed tomography within 4 weeks of vaccination and exclusion of other possible etiologies.
Results
From the survey, 49 cases of vaccine-associated pneumonitis were identified between February 27 and October 30, 2021. After multidisciplinary discussion, 46 cases were analyzed. The median age was 66 years and 28 (61%) were male. The median interval between vaccination and respiratory symptoms was 5 days. There were 20 (43%), 17 (37%), and nine (19%) patients with newly identified pneumonitis, exacerbation of pre-diagnosed ILD, and undetermined pre-existing ILD, respectively. The administered vaccines were BNT162b2 and ChAdOx1 nCov-19/AZD1222 each in 21 patients followed by mRNA-1273 in three, and Ad26. COV2.S in one patient. Except for five patients with mild disease, 41 (89%) patients were treated with corticosteroid. Significant improvement was observed in 26 (57%) patients including four patients who did not receive treatment. However, ILD aggravated in 9 (20%) patients despite treatment. Mortality was observed in eight (17%) patients.
Conclusion
These results suggest pneumonitis as a potentially significant safety concern for vaccines against SARS-CoV-2. Clinical awareness and patient education are necessary for early recognition and prompt management. Additional research is warranted to identify the epidemiology and characterize the pathophysiology of vaccine-associated pneumonitis.

Keyword

COVID-19; Interstitial Lung Disease; Pneumonitis; SARS-CoV-2; Vaccine

Figure

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  Fig. 1 Chest high-resolution computed tomography and histopathology of vaccine-associated interstitial lung disease in a 56-year-old female patient who received the first dose of BNT162b COVID-19 vaccine. Axial (panel A and B) high-resolution CT images show bilateral patch consolidation along bronchovascular bundles in lower lung zones and ground-glass opacities in upper lung zones. Lung specimen (panel C, H&E stain, ×1 original magnification) obtained by surgical biopsy. Lower power magnification (panel E and D, H&E stain, ×15 magnification) demonstrates multiple fibroblastic plugs in alveolar sacs (organizing pneumonia pattern) and uniform interstitial inflammation and thickening with lymphocytes (cellular nonspecific interstitial pneumonia pattern). High-magnification (panel F, H&E stain, ×100 magnification) shows lymphocyte infiltration in interstitium.

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